Total joint arthroplasty refers to the restoration of joint function and stability through bony and ligamentous reconstruction. It is considered among the most reliable and reproducible surgical procedures in modern medicine and expected to increase drastically in demand over the next 20 years. This article provides an overview of the rationale behind implant design and how fixation in arthroplasty, specifically total hip arthroplasty, is achieved. The biomechanics of the hip joint and its associated radiologic landmarks are reviewed. This is then followed by a description of the design features of acetabular and femoral components, with concise explanations of why cemented and cementless implants exist, how different implant geometries and porous coatings address specific clinical needs, and how we hope the current innovations in cementless fixation will improve outcomes in revision surgery.
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